title: The influence of community and individual health literacy on self-reported health status.
abstract: BACKGROUND
  Individual health literacy is an established predictor of individual health outcomes. Community-level health literacy may also impact individual health, yet limited research has simultaneously considered the influence of individual and community health literacy on individual health.
  
  
  OBJECTIVE
  The study goal was to determine if community health literacy had an independent relationship with individual self-reported health beyond individual health literacy.
  
  
  METHODS
  We used data from the 2008 and 2010 Hawai'i Health Survey, a representative statewide telephone survey. Multilevel models predicted individual self-reported health by both individual and community health literacy, controlling for relevant individual-level (education, race/ethnicity, gender, poverty, insurance status, age, and marital status) and community-level variables (community poverty and community education).
  
  
  METHODS
  The sample included 11,779 individuals within 37 communities.
  
  
  METHODS
  Individual health literacy was defined by validated self-reported measurement. Communities were defined by zip code combinations. Community health literacy was defined as the percentage of individuals within a community reporting low health literacy. Census data by ZIP Code Tabulation Areas provided community-level variables.
  
  
  RESULTS
  In descriptive results, 18.2 % self-reported low health literacy, and 14.7 % reported self-reported poor health. Community-level low health literacy ranged from 5.37 % to 35.99 %. In final, multilevel models, both individual (OR: 2.00; 95 % CI: 1.63-2.44) and community low health literacy (OR: 1.02; 95 % CI: 1.00-1.03) were significantly positively associated with self-reported poor health status. Each percentage increase of average low health literacy within a community was associated with an approximately 2 % increase in poor self-reported health for individuals in that community. Also associated with poorer health were lower educational attainment, older age, poverty, and non-White race.
  
  
  CONCLUSIONS
  Both individual and community health literacy are significant, distinct correlates of individual general health status. Primary care providers and facilities should consider and address health literacy at both community and individual levels.
authors.affiliation: Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Biomed D104-G, Honolulu, HI, 96821, USA, tsentell@hawaii.edu.
authors.forename: Tetine
authors.initials: T
authors.lastname: Sentell
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: James
authors.initials: J
authors.lastname: Davis
authors.forename: Kathleen Kromer
authors.initials: KK
authors.lastname: Baker
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Braun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006254:Hawaii / Q000208:ethnology; D057220:Health Literacy / Q000191:economics / Q000592:standards*; D006304:Health Status; D006306:Health Surveys / Q000191:economics / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012111:Residence Characteristics; D057566:Self Report / Q000191:economics / Q000592:standards*; D012959:Socioeconomic Factors; D055815:Young Adult